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Volume 220 (2010)
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- Issue 3 Pages 177-
- Issue 2 Pages 95-
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Volume 220, Issue 3
March
Displaying 1-10 of 10 articles from this issue
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Regular Contributions
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Hisashi Masugata, Shoichi Senda, Jun Hoshikawa, Koji Murao, Naohisa Ho ...2010 Volume 220 Issue 3 Pages 177-182
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSBrachial-ankle pulse wave velocity (baPWV) is widely used as a marker of arterial stiffness, but there are no data regarding the usefulness of measuring baPWV in hypertensive patients after stroke. The purpose of this study was to examine the clinical significance of baPWV by assessing its correlation with echocardiographic parameters in hypertensive patients after stroke. The study enrolled 61 hypertensives after stroke (24 patients with cerebral infarction and 37 with cerebral hemorrhage) and 61 age-matched hypertensives without stroke. Left ventricular (LV) hypertrophy was evaluated by measuring LV mass index (LVMI) and relative wall thickness (RWT), and LV diastolic function was evaluated by measuring peak early mitral annular velocities (E') using echocardiography. Concentric LV hypertrophy showing increased RWT (0.50 ± 0.12) was observed in hypertensives after stroke, but not in hypertensives without stroke. In hypertensives after stroke, elevated baPWV correlated with age (r = 0.60, p < 0.001), systolic blood pressure (r = 0.56, p < 0.001), increased LVMI (r = 0.47, p < 0.001), and decreased E' (r = −0.40, p = 0.002). Multiple regression analysis showed that age (β coefficient = 0.43, p < 0.001), systolic blood pressure (β coefficient = 0.40, p < 0.001), and LVMI (β coefficient = 0.25, p = 0.008) were independent determinants of elevated baPWV. In conclusion, elevated baPWV is more closely associated with LV hypertrophy than with LV diastolic dysfunction. Elevated baPWV is independently associated with the severity of LV hypertrophy adjusted with systolic blood pressure and age in hypertensive patients after stroke.View full abstractDownload PDF (314K) -
Koichi Suzuki, Eishin Oki, Kazushi Tsuruga, Tomomi Aizawa-Yashiro, Ets ...2010 Volume 220 Issue 3 Pages 183-186
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSCyclosporine A (CsA) is an effective steroid-sparing agent for patients with steroid-dependent, relapsing nephrotic syndrome (SDRNS). The efficacy and safety of single-daily dose administration (SDD protocol) of CsA in selected patients with SDRNS has been reported. However, the efficacy of initial CsA treatment for children with SDRNS using the SDD protocol remains to be elucidated. The SDD protocol might be associated with lower clinical toxicity, compared to the conventional twice-daily dose administration (TDD protocol). Here we evaluated the efficacy and safety of the SDD protocol versus the TDD protocol in patients with SDRNS. The data from 19 patients (9.9 ± 4.2 years old) were retrospectively collected and analyzed. Ten patients treated according to the SDD protocol for a mean of 27 months (SDD group), while 9 patients treated with the TDD protocol for a mean of 35 months (TDD group) as an initial CsA treatment. Although the mean daily CsA dose was significantly lower in the SDD group (1.5 ± 0.4 mg/kg/day vs. 3.7 ± 0.7 mg/kg/day, P < 0.01), there were no differences between the two groups in the mean minimum dose of prednisolone required for maintenance of clinical remission nor in the calculated relapse rate. One patient in the TDD group developed biopsy-proven mild CsA nephrotoxicity, whereas no patient in the SDD group showed nephrotoxicity. Despite a small number of patients, this study may support that the SDD protocol is at least as effective as the conventional TDD protocol, and is more cost-effective for selected children with SDRNS.View full abstractDownload PDF (225K) -
Chih-Ming Lin, Kelvin Hong2010 Volume 220 Issue 3 Pages 187-190
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSThough rare, primary intracranial tumors can present with Parkinsonian symptoms, and diagnosis can be delayed unless there is a high index of suspicion. We herein present an 81-year-old man who was seen in our neurology clinic due to acute onset of unsteady gait and altered consciousness. Parkinsonism was initially diagnosed because of the typical manifestations. Levodopa was prescribed; however, there was a limited effect on his symptoms. Upon detail history and neurological examination, left sided hemiparesis was disclosed. Cerebral imaging studies revealed a solid mass over the right infratentorial para-midbrain area leading to reactive obstructive hydrocephalus. Work-up including chest and abdominal CT scanning, upper and lower GI endoscopy, and tumor marker studies failed to uncover any abnormalities. A neurosurgeon was consulted and a shunt procedure and biopsy of the infratentorial mass were performed. Histopathological examination of the biopsy tissue revealed tumor diffusely intermixed with large cells consistent with large B-cell lymphoma. The patient and his family declined further treatment. Though rare, cerebral tumors can present with Parkinsonian features and represent a diagnostic challenge. Clinicians should be aware of the possibility of cerebral neoplasms causing Parkinsonism, and include them in the differential diagnosis, especially for patients presenting with atypical Parkinsonian features, or those not responsive to initial therapy.View full abstractDownload PDF (1247K) -
Etsuko Nakamura, Naohito Tanabe, Akiko Sekii, Akiko Honda, Emiko Hoshi ...2010 Volume 220 Issue 3 Pages 191-198
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSRetaining experienced nurses is an indispensable part of securing the safety and reliability of medical care. In this study, we investigate how the working conditions affect staff nurses' intention to remain in their current employment positions (intention to remain employed). A total of 319 staff nurses working for three private hospitals were given a questionnaire in order to evaluate their working conditions. A stepwise multiple logistic regression analysis selected 5 out of 44 question items as significant independent variables for their intention to remain employed; they were assumed to directly affect their intentions (direct modulators). From the remaining 39 items, seven meaningful factors were extracted via factor analysis. We constructed a path network model so that these factors would indirectly affect the intention to remain employed via any of the five direct modulators (indirect modulators). In this network, the factor, “Rapport with coworkers” had the strongest positive effect on three of the five direct modulators (β = 0.28-0.55, p < 0.05). According to factor loadings, positive teamwork together with appropriate supervision and recognition from superiors and colleagues seems to characterize this factor, and therefore, may play a key role in retaining staff nurses in their current positions. Two indirect modulators related to “Management by Objectives” (MBO)—“Understanding MBO” and “Clear personal objectives” also played negligible roles in this path model. These findings could be helpful in improving management systems of the nursing sections of hospitals, which could contribute to retaining staff nurses in their current employment positions.View full abstractDownload PDF (477K) -
Yuki Tanaka, Hiroaki Komori, Shiro Mori, Yoshiko Soga, Takahito Tsubak ...2010 Volume 220 Issue 3 Pages 199-206
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSEnzyme-linked immunosorbent assays (ELISA) have been widely used to determine quantitatively autoantibodies. However, the processes for the purification and immobilization of antigens in conventional ELISA methods include multiple steps, which have hampered the application for screening of autoantibodies. Here, we have developed a novel ELISA system using the plates pre-coated with glutathione casein to capture recombinant proteins fused to N-terminal glutathione S-transferase (GST). The GST-fused proteins were synthesized with the wheat germ cell-free protein production system. Thus, the present system combined the GST-capture ELISA with the cell-free protein production system, which allowed immobilization of the recombinant proteins with one-step purification. Using this ELISA method, we determined whether rheumatoid factors (RF), which have been considered as one of the representative disease−specific autoantibodies for rheumatoid arthritis (RA), were genetically associated with severity of arthritis in a mouse model for RA, MRL/Mp-lpr/lpr (MRL/lpr). GST-fused human IgG1-Fc (GST-Fc), synthesized with the robotic protein synthesizer, were used as reactants for RF. Serum samples for RF were prepared from 11 lines of a recombinant inbred mouse strain, MXH/lpr, which was established from intercrosses between MRL/lpr and non-arthritic C3H/HeJ-lpr/lpr (C3H/lpr) strains, composed of a different genomic recombination derived from the parental strains in each line. A correlation of RF titers with the severity of the arthritis in these lines was not significant, indicating genetic dissociation of RF from arthritis and that RF is not necessarily required for the development of RA. The present method may provide high-throughput screening for determining the disease-specific autoantibodies in autoimmune diseases.View full abstractDownload PDF (873K) -
Shuichiro Takahashi, Sho Takagi, Hisashi Shiga, Ken Umemura, Katuya En ...2010 Volume 220 Issue 3 Pages 207-215
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSThe main goal of Crohn's disease (CD) treatment at present is to induce and maintain remission for as long as possible, and several approaches have been used as induction and maintenance therapies. There are no reports that have compared the effects on mid- and long-term prognosis among the induction and maintenance therapies, especially between infliximab, a chimeric antibody to tumor necrosis factor-α, and nutritional therapies. A total of 262 CD patients with induced remission were enrolled in the cohort study. Patients who failed to achieve remission, and patients who were lost to follow-up within 12 months were excluded. Induction therapies for CD included total elemental enteral nutrition, total parenteral nutrition, infliximab, prednisolone, and surgical resection. Maintenance therapies included home elemental diet, 5-aminosalicylates, immunomodulators, and scheduled infliximab therapy. We evaluated the possible predictive factors of relapse and surgical recurrence including the clinical backgrounds of the patients and medical therapies, using the Cox multivariate hazard analysis. The main factors that strongly affected the first relapse were scheduled infliximab therapy (hazard ratio (HR) = 0.24, p < 0.0001), surgical induction (HR = 0.19, p < 0.0001) and high frequency of previous relapse (HR = 2.56, p = 0.002). Penetrating (HR = 3.33, p = 0.009) and stricturing (HR = 6.60, p < 0.0001) disease behavior were main risk factors of surgical recurrence. Scheduled infliximab therapy is the most effective maintenance therapy in a real clinical setting with respect to the mid- and long-term prognosis.View full abstractDownload PDF (542K) -
Yoshinori Hattori, Yoshiyuki Shimizu, Chiaki Satoh, Makoto Watanabe2010 Volume 220 Issue 3 Pages 217-222
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSThe masticatory motion, whereby food introduced into the mouth is processed into a bolus suitable for swallowing, can be divided into successive masticatory cycles, each comprising downward and subsequent upward movements of the mandible. The present study deals with the problem of the existence of muscle synergies in mastication, that is whether some of the muscles involved in mastication receive common motor drives, rather than controlled individually. Evidence for muscle synergy during mastication is scarce, partly due to the difficulties in simultaneous recording of the electromyographic (EMG) activities from all the muscles involved. Thus, we analyzed the variability of the mandibular motion during mastication rather than to examine the EMG patterns, based on the hypothesis that a motion elicited by a limited set of muscle synergies can be approximated as a superposition of the same number of independent motions. Mandibular motion paths were recorded from 8 healthy males (25-31 years), who chewed gum or gummy candy. A morphometric technique, which describes the shape of a closed curve by using normalized elliptic Fourier descriptors and reduces the variance of the shape by using principal component analysis, was applied to analyze the variability of the mandibular motion paths. We found three independent variations of the motion paths, whose linear combinations accounted for an average of 93% (range, 88-96%) of the total variance. The extracted variations were similar among the subjects. These findings provide indirect evidence for the existence of a limited set of muscle synergies for mastication in humans.View full abstractDownload PDF (266K) -
Qiong Xie, Shui-Ping Zhao, Feng Li2010 Volume 220 Issue 3 Pages 223-228
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSCholesterol efflux is the key step of reverse cholesterol transport and has become a therapeutic target against atherosclerosis. Human apolipoprotein A-I (apoA-I) is the main protein in high-density lipoprotein (HDL) and has 243 amino acids. ApoA-I mimetic peptides have no sequence homology to apoA-I but possess the class-A amphipathic helical motif that presents in apoA-I lipid binding domains. D-4F is one of the apoA-I mimetic peptides and exerts diverse atheroprotective functions similar to apoA-I. However, the exact role of D-4F on lipid metabolism in macrophages is not clear yet. Therefore, we studied the effect of D-4F on cholesterol efflux, cAMP levels and expression of ATP-binding cassette transporter A1 (ABCA1) in RAW264.7 mouse macrophages. Cells were incubated with 1, 10, 50 or 100 μg/ml D-4F for 24 hours, and the cholesterol efflux was assessed. Here, D-4F significantly increased the cholesterol efflux in concentration- and time-dependent manners. Concomitantly, D-4F increased intracellular cAMP levels and the expression levels of ABCA1 mRNA and protein in a dose-dependent manner, consistent with the increase in the cholesterol efflux from macrophages. 8-Br-cAMP (cAMP activator) increased the D-4F-mediated cholesterol efflux by 39%. Moreover, the increases in cholesterol efflux and ABCA1 expression induced by 8-Br-cAMP could be inhibited by the treatment with H89, a protein kinase A (PKA) inhibitor. In conclusion, these results suggest that the synthetic peptide D-4F promotes cholesterol efflux in macrophages through the cAMP-PKA-ABCA1 pathway, which may open new avenues for the treatment of atherosclerosis.View full abstractDownload PDF (328K) -
Tadashi Yasuda2010 Volume 220 Issue 3 Pages 229-235
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSProstaglandin E2 (PGE2) is one of the key mediators of inflammation in affected joints of rheumatoid arthritis (RA). Intra-articular injection of high molecular weight hyaluronan (HA) into RA knee joints relieves arthritic pain. Although HA has been shown to inhibit PGE2 production in cytokine-stimulated synovial fibroblasts, it remains unclear how HA suppresses PGE2 production in activated cells. Furthermore, HA effect on macrophages has rarely been investigated in spite of their contribution to RA joint pathology. This study was aimed to investigate the inhibitory mechanism of HA on lipopolysaccharide (LPS)-stimulated PGE2 production in U937 human macrophages. Stimulation of U937 macrophages with LPS enhanced PGE2 production in association with increased protein levels of cyclooxygenase-2 (COX-2). Pretreatment with HA of 2,700 kDa resulted in suppression of the LPS-mediated induction of COX-2, leading to a decrease in PGE2 production. Likewise, the LPS-stimulated PGE2 production was inhibited by the pretreatment with a specific COX2 inhibitor, NS-398, or a specific inhibitor of nuclear factor (NF)-κB, BAY11-7085. HA also decreased the degree of phosphorylation and nuclear translocation of NF-κB enhanced by LPS. Fluorescence cytochemistry demonstrated that HA bound to CD44, the principal HA receptor, on U937 macrophages. Anti-CD44 antibody reversed the inhibitory effects of HA on the LPS-mediated increase in PGE2 production, COX-2 induction, and activation of NF-κB. These results indicate that HA suppresses the LPS-stimulated PGE2 production via CD44 through down-regulation of NF-κB. Administration of HA into RA joints may decrease PGE2 production by activated macrophages, which could result in improvement of arthritic pain.View full abstractDownload PDF (413K) -
Yasushi Kudo, Shigeri Kido, Machiko Taruzuka Shahzad, Kyoko Shida, Tos ...2010 Volume 220 Issue 3 Pages 237-245
Published: 2010
Released on J-STAGE: March 06, 2010
JOURNAL FREE ACCESSProper work environments are important for nurses to feel motivated. We examined the associations between work motivation and job satisfaction among Japanese nurses to improve their motivation. In Japan, relatively small and medium-sized private hospitals play a central role in the healthcare industry. In the present study, the subjects were nurses working in 23 small and medium-sized private hospitals that had 65 to 326 beds. We analyzed 1,116 registered and licensed practical female nurses (average age, 38.3 years; standard deviation, 11.3 years). Many nurses with their specialized nursing skills dedicate themselves to patient care. However, many of these nurses may not be interested in contributing to their hospitals. Nurses may have different opinions regarding dedication to patient care and contribution to their hospitals. Therefore, concerning work motivation, we produced these two different items, “Nurses' dedication to patients” and “Nurses' contribution to their hospitals.” We also produced our own original new job satisfaction questionnaire. We found 7 facets of job satisfaction: “Work as specialists,” “Workplace safety,” “Relationships with superiors,” “Work-life balance,” “Relationships among nurses,” “Communications with physicians,” and “Salary.” Multiple linear regression analyses show that both “Nurses' dedication to patients” and “Nurses' contribution to their hospitals” were significantly associated with “Work as specialists.” Nurses feel their jobs of protecting people's lives and health are valuable. They do not feel motivated only by money. They value the intrinsic nature of their jobs. Creating proper work environments is important for nurses to be able to work as specialists.View full abstractDownload PDF (492K)
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